Traumatic injury is a leading cause of death and disability worldwide, and in America causes more deaths in the first half of the lifespan than all other diseases combined. The magnitude of the costs of injury and resulting disability to individuals, families, and society is staggering. The medical costs and productivity losses associated with injury in the US exceed $400 billion annually. Despite the profound impact of injury on the US population, funds directed to injury research and injury prevention initiatives are minute when compared to those dedicated to other diseases. Less than 0.5% of the research budget of the NIH over the last 4 years has been directed to injury-related activities. With funding for injury prevention limited, an effort to prioritize injury mechanisms (eg, motor vehicle crash~ fall~ drowning) according to the relative magnitude of their burden is essential. Research and prevention efforts could then be focused on the injury mechanisms identified to carry a disproportionate share of the burden. However, the challenge of determining priorities for the allocation of injury prevention funding is far from straightforward. Different indices have been used to quantify the burden of injuries, to examine frequency, mortality, morbidity, or monetary costs. However, research that has tried to identify the injury types that warrant being focused on as priorities typically study only one more two indices. In part this is because data to enable a more comprehensive evaluation are lacking. Also, the divergent foci of these indices and the different metrics of their scales make comparisons between them difficult to do objectively. Also, efforts have been based on data that are not nationally representative and thus cannot be used to make prevention recommendations responsibly. We recently applied a novel method for prioritizing injury mechanisms in a fashion that accounts for the frequency of an injury mechanism in a given population as well as the severity (that is, anatomic damage) of each injury mechanism. This method improves greatly upon past attempts, which examine either frequency or severity separately, and in so doing may yield misleading results about which injury mechanisms are actually high-burden priorities. We also developed innovative new indices that enabled comparing injury mechanisms in terms of three additional criteria: their relative burden in terms of mortality, hospital costs, and years of potential life lost. Building upon that methodological advancement, this application proposes a highly innovative approach that combines nationally representative emergency department data with national mortality data to represent all deaths occurring in the US in 2007. Additionally, we incorporate data on lifetime medical and work loss costs, thereby enabling injury mechanisms to be quantified according to fully six criteria of burden. By utilizing these comprehensive data with our novel methodological approach, this proposal capitalizes on the opportunity make a major advancement in our understanding of the injury prevention priorities in the US. We will also identify the injury prevention priorities in specific subgroups and will communicate the findings policy makers to enable injury prevention planning to be accomplished objectively.

Public Health Relevance

This application comprehensive brings together data from three nationally representative sources to represent injury victims in the United States of all ages, including those treated in hospitals and those who died and were not transported to a hospital. An innovative methodologic approach to measuring the relative injury severity of each specific mechanism of injury (eg, burns, falls, drowning) will be applied. The result will be to objectively quantify the burden of injury mechanisms in the US according to their overall ranking as measured by six criteria, including lifetime medical costs and work loss costs. The methods will be stratified to focus separately on 13 age groups, on women and men separately, on different regions of the country, and on different areas of the country as defined along a rural-urban continuum. The results will provide objective guidance that will be communicated to policy makers. The results of this study will provide much needed objective data that can used to develop and implement injury prevention strategies tailored to yield the greatest public health benefit.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Small Research Grants (R03)
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Special Emphasis Panel (ZRG1-HDM-Q (54))
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Haverkos, Lynne
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University of Pennsylvania
Biostatistics & Other Math Sci
Schools of Medicine
United States
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